A new study has found that mental health workers are more likely to be depressed or anxious when they experience discrimination from their managers than when it comes from patients.
Discrimination from the patients' visitors also causes more distress than discrimination from the patients.
A research team led by Professor Stephen Wood at the University of Leicester's School of Management looked at the effects of prejudice, including sex, racial and age discrimination, from different groups of people on mental health workers.
The study, funded by the Department of Health National Institute for Health Research, draws on the experience of 1,733 mental health workers in the UK, including doctors, nurses, psychiatrists and support staff.
The researchers distributed questionnaires to every worker in 100 wards and 36 outpatient teams, measuring four states of mind - anxiety, depression, emotional exhaustion and job satisfaction.
It also looked at whether they had experienced discrimination in the past year, alongside more general questions such as how fair they perceived their organisation to be.
They then used advanced statistical analysis to assess whether workers who suffered discrimination at the hands of four different groups of people - patients, visitors, managers and co-workers - were more or less likely than other workers to have negative feelings.
From the four different discrimination sources, discrimination from managers had the largest impact on the anxiety, depression, emotional exhaustion and job dissatisfaction of the mental health worker.
In addition, and perhaps surprisingly, discrimination from patients' visitors had a larger impact on depression and emotional exhaustion than discrimination from the patients themselves. Discrimination from one's fellow workers had less effect on any form of distress than that from managers or visitors.
"The finding that managers can distress workers the most can be explained by managers' large power over staff's working lives, including their chances of keeping a job and winning promotion. Moreover, workers feel distressed if they feel the organisation employing them is not treating them fairly - and the behaviour of managers is key to this sense of fairness," Professor Stephen Wood said.
"Aggression from relatives and other visitors is, like aggression from managers, viewed as reflecting badly on the procedures and fairness of the organisation. However, aggression from patients is not readily attributed to failings in the organisation," he added.